Provider Demographics
NPI:1437790805
Name:FUJITA MAUS, QUDDUS (LPC)
Entity Type:Individual
Prefix:
First Name:QUDDUS
Middle Name:
Last Name:FUJITA MAUS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 IRIS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2043
Mailing Address - Country:US
Mailing Address - Phone:512-644-8598
Mailing Address - Fax:
Practice Address - Street 1:3775 IRIS AVE STE 6
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-2043
Practice Address - Country:US
Practice Address - Phone:512-644-8598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0015547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health